Doctor Answers 5

Breast Reduction and Insurance Coverage?

December 29th, 2011

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Unfortunately, the only way to know about your specific policy is to call the insurance company directly.

The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Make sure you're saying a well-trained/experienced board-certified plastic surgeon.

Insurance coverage for breast lift or breast reduction.

Answer by George J. Beraka, MDManhattan Plastic Surgeon80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points.

1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches.

2) Very big reductions (like from an F cup to a C cup) will usually be covered.

3) Many policies will pay for breast reduction if 500 grams (a little more than a pound) or more are removed from each breast.

4) Some policies take your height and weight into account. So that if you are tiny, smaller reductions will be covered. Find out the details of your policy.

5) DON'T get too much of a reduction just to satisfy the insurance company. You will be unhappy with tiny breasts.

6) Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible.

8) Some companies require that you try "alternative treatments" such as weight loss and physical therapy first.

9) Don't give up. If the first request is denied, demand an appeal.

10) If there is no insurance, and you cannot afford to pay a private surgeon, go to the plastic surgery clinic of a teaching hospital. There, residents do the surgery under supervision, and the cost is minimal. In New York City, we train residents and fellows at Lenox Hill Hospital, and they do good work.

Breast Reduction Pictures

Insurance may cover breast reduction surgery

Insurance coverage for breast reduction surgery has become more difficult over the years with insurance companies tightening their requirements for approval.

To optomize your chances of being approved you should first go to your insurance companies website. There you will find the requirements necessary for you to meet to be approved. A letter from your primary care physician, in addition to one from a plastic surgeon (along with pictures), are usually required. There is also a minimum amount of breast tissue you will need to have removed for your surgery to be approved. Your plastic surgeon will submit supporting documentation on your behalf in hopes of obtaining approval for you.

These answers are for educational purposes and should not be relied upon as
a substitute for medical advice you may receive from your physician. If you
have a medical emergency, please call 911. These answers do not constitute
or initiate a patient/doctor relationship.